When it comes to addiction treatment, many people hesitate because of affordability concerns. The 2016 National Survey on Drug Use and Health (NSDUH) from the Substance Abuse and Mental Health Administrative Services (SAMHSA) listed concerns about cost as the second most common reason people did not pursue treatment (26.9%). Cost can be a barrier to getting the help they need.
Understanding if insurance covers drug rehab can help you or a loved one make an informed decision about treatment and put you on a path to success. This article will explain the types of insurance that cover rehab, the types of treatment services that are likely to be covered, how to verify your insurance coverage, and what to do if your insurance does not cover drug rehab.
Does Health Insurance Cover Drug Rehab?
The Affordable Care Act (ACA) requires insurance plans to include substance use disorder services as one of the ten elements of essential health benefits. As a result, any insurance plans sold on the Health Insurance Exchange or provided by Medicaid include services for substance use disorders. Medicare and employer-sponsored insurance plans are likely to also have coverage, but it may vary by plan. State-funded insurance or military insurance like TRICARE or through the VA are likely to provide benefits for substance use treatment.
What Types of Drug Rehab Services are Covered by Insurance?
Coverages will vary; it is always best to check with your insurance provider or even the drug rehab center you are considering. The following services are often covered, at least partially:
- Detox Services
- Inpatient RehabÂ
- Outpatient RehabÂ
- Medication-Assisted Treatment (MAT)Â
- Therapy and CounselingÂ
- Aftercare Support
How Can I Verify My Insurance Covers Drug Rehab?
Start with your insurance provider to verify your coverage and benefits. You should have received a Summary of Benefits document at enrollment; often, these can be quickly accessed through your provider’s self-service portal. Calling your provider and speaking to a representative can sometimes be easier, and you might be able to request a proof of authorization document or email for peace of mind. If you haven’t found a provider for drug rehab, you can also ask the representative or search the portal for those in your network.
If you’ve already found a potential provider, they should also be able to assist with verifying your coverage. Some will even have a link on their website for this purpose. When it comes to understanding additional out-of-pocket costs, it is essential to talk to both your insurance provider and the potential drug rehab directly. Expect the drug rehab to be helpful–it is in their financial interest to help you enter rehab, and most are genuinely interested in helping others on the path to recovery. Both of these entities can help you gain a full picture of what it will cost you to enter drug rehab, complete with deductibles, co-pays, and maximum coverage limits.
What if My Insurance Doesn’t Cover Drug Rehab?
If your insurance doesn’t cover drug rehab, or there are significant gaps between the coverage and what you can manage out of pocket, here are a few alternatives to explore.
- Scholarships and grants. Some nonprofit organizations and even treatment centers provide financial assistance to those in need. Ask people and facilities in your area if they know of any opportunities.Â
- Sliding scale fees or financing plans. Some rehab centers adjust their costs based on a person’s ability to pay, so contact the rehab center directly to ask about financial assistance. Some will also offer financing options or payment plans that don’t require as much money upfront.
- State-funded programs. Some states make mental health and substance use services available through state funding. Explore your county and state websites to find opportunities to support your needs.
Using Insurance at The ARTS Intensive Outpatient Program
We accept several insurances at The Addiction Recovery and Treatment Services (The ARTS). We understand that cost is, unfortunately, a barrier to care for many people. If you have been considering treatment for yourself or a loved one, we welcome the opportunity to talk with you about your situation. Understanding if insurance covers drug rehab or the total costs associated with treatment can be overwhelming at first, but you are not alone! Our caring, compassionate staff understand addiction and are committed to helping you through it. Reach out to us today and take the next step to recovery.
